The present invention relates, in general, to surgical instruments and procedures and, in particular, to the cleaning of arteries to remove plaque build-ups.
It has been common practice to open the full selected length of an artery which is to be cleaned of plaque build-ups and tediously separate the inner layers (i.e. the xe2x80x9ccorexe2x80x9d) from the outer layers to remove the plaque build-ups along the length of the artery after which the full length of the opening is sutured closed using the outer layers for the closure. Because such incisions, for example, can extend along the entire length of the leg from the groin to the foot, such a procedure is a massive surgical invasion.
As the length of the incision increases, the difficulty of the surgical procedure increases.
Another procedure, involving relatively small incisions at the ends of the artery section to be cleaned, also has been performed in the past for the removal of plaque build-ups. In this procedure, plaque build-ups are removed or loosened by forceps which are introduced at the two incisions to xe2x80x9ccore outxe2x80x9d the artery. To remove residue plaque, a xe2x80x9cstripperxe2x80x9d (e.g. a catheter-type unit) is passed through the entire blocked artery from the upper incision to the lower incision and a certain, limited amount of residue plaque is pushed out through the lower incision. A swab is secured to the leading end of the catheter-type unit after it has emerged through the lower incision. Upon retraction of the catheter-type unit, the swab carries residue plaque toward and out from the upper incision. Thereafter, the two incisions are closed. Because this procedure is xe2x80x9cblindxe2x80x9d in that the artery section being cleaned is not open and exposed, it is inherently dangerous. Also, the second incision is necessary either for an exit of plaque or to gain access to the catheter-type unit for affixing the swab.
In another technique for the removal of plaque build-ups, known as gas endarterectomy, a jet of carbon dioxide gas is injected into the wall of an artery to create a xe2x80x9cseparation plane.xe2x80x9d A small opening is made in the artery and a special gas spatula, carefully designed not to injure the artery, is passed down the separation plane as carbon dioxide gas passes through the spatula further freeing up the entire length of the inner core. The inner core then is removed by transecting the distal end and pulling the entire core out of the proximal opening in the artery after which the two openings are closed. Because this procedure also is xe2x80x9cblindxe2x80x9d in that the artery section being cleaned is not open and exposed, it is inherently dangerous. Also, this procedure requires at least two surgical incisions to expose both ends of the artery section to be cleaned and two openings in the artery itself.
Gas endarterectomy also has been carried out by first surgically opening the body part, but not the artery which is to be cleaned, along the full selected length of the artery and then performing the gas endarterectomy by viewing the probing of the artery through the sufficiently transparent artery wall. Such a procedure also is a massive surgical invasion. As the length of the incision increases, the difficulty of the surgical procedure increases.
Because of the difficulties and hazards associated with the surgical procedures described above, bypass surgical procedures became popular. Istead of cleaning out a plaque build-up in an artery, the section of the artery having the plaque build-up is bypassed surgically. Such a bypass procedure also is a massive surgical invasion. As the length of the bypass increases, the difficulty of the surgical procedure increases.
At the present time, there is a trend for reducing the degree of invasion in surgical procedures. Consequently, more and more renewed interest is being expressed in gas endarterectomy which reduces surgical invasion and the period of time the patient must remain in the hospital.
The present invention is new surgical instruments and a new surgical procedure for performing gas endarterectomy through only one, relatively small incision.
An endarterectomy surgical instrument, constructed in accordance with the present invention, includes a spatula tip having at a first end thereof an optics opening and a plurality of fluid openings. This endarterectomy surgical instrument also has first flexible tubular means extending through the spatula tip from the optics opening in the spatula tip for conducting a light from a remote end of the first flexible tubular means through the optics opening to a surgical site and an image of the surgical site through the optics opening to the remote end of the first flexible tubular means. This endarterectomy surgical instrument also has second flexible tubular means extending through the spatula tip from the fluid openings in the spatula tip for conducting a fluid from a remote end of the second flexible tubular means through the fluid openings to the surgical site. This endarterectomy surgical instrument further has connector means adapted for connection to a light source, an image forming unit, and a fluid source and to which the remote end of the first flexible tubular means and the remote end of the second flexible tubular means are connected for conducting the light from the light source to the first flexible tubular means, the image of the surgical site from the first flexible tubular means to the image forming unit, and fluid from the fluid source to the second flexible tubular means
An endarterectomy surgical procedure for removing a plaque build-up from a selected length of an artery, performed in accordance with the present invention, includes making only one incision at a first end of a selected length of an artery from which a plaque build-up is to be removed to expose the artery. This endarterectomy surgical procedure also includes inserting a spatula into the artery at the incision between the adventitia layer and the media layer of the artery and probing the selected length of the artery with the spatula while applying a fluid to increase the space between the adventitia layer and the media layer of the artery. This endarterectomy surgical procedure further includes continuously developing an image of the surgical site at the spatula as the artery is probed and viewing the image of the surgical site while probing the artery. Also included in this endarterectomy surgical procedure are terminating probing of the artery at a second end of the selected length of the artery and retracting the spatula and removing the spatula from the artery through the incision. Next, this endarterectomy surgical procedure includes removing the plaque build-up from the artery and treating the termination transition at the second end of the selected length of the artery. This endarterectomy surgical procedure is concluded by closing the incision.
If it is necessary to cut the plaque build-up so that it can be removed, a first surgical instrument, constructed in accordance with the present invention, includes an elongated flexible stem unit, a handle at a first end of the elongated flexible stem unit, and a cutting unit at a second end of the elongated flexible stem unit, opposite from the first end. The cutting unit has an inner cutting edge and a curved outer blunt edge.
A second surgical instrument, constructed in accordance with the present invention for cutting plaque build-ups, includes an elongated tubular support unit and a cutting wire unit extending through the elongated tubular support unit and freely movable within the elongated tubular support unit. The free ends of the cutting wire unit project from a first end of the elongated tubular support unit and a closed loop portion of the cutting wire unit projects from a second end of the elongated tubular support unit.